Elsevier

American Heart Journal

Volume 166, Issue 4, October 2013, Pages 729-736
American Heart Journal

Clinical Investigation
Acute Ischemic Heart Disease
Effect of marital status on the outcome of patients undergoing elective or urgent coronary revascularization

https://doi.org/10.1016/j.ahj.2013.07.018Get rights and content

Background

Marriage confers various health advantages in the general population. However, the added value of marriage among patients who undergo percutaneous coronary intervention (PCI) beyond the standard cardiovascular risk factors is not clear. This study aimed to assess the effects of marital status on outcomes of patients undergoing elective or urgent PCI.

Methods

Clinical observational analysis of consecutive patients undergoing elective or urgent PCI from 1993 to 2011 was performed. Patients were stratified by marital status, comparing married to unmarried patients. Clinical outcome up to 12 months was obtained by telephone contact or office visit. A total of 11,216 patients were included in the present analysis; 55% were married and 45% unmarried.

Results

Significant differences in baseline characteristics were noted, including a lower prevalence of hypertension (86% vs 88%), diabetes (34% vs 38%), and smoking (19% vs 25%) among married vs unmarried patients, respectively (P < .001). However, married patients had a higher prevalence of hypercholesterolemia and family history of coronary artery disease. Early and late major adverse cardiac event rates were significantly lower for married vs unmarried patients up to 1 year (13.3% vs 8.2%, P < .001). Married status was independently associated with improved outcome in multivariable analysis (hazard ratio 0.7, 95% CI 0.6-0.9).

Conclusions

Married patients who undergo urgent or elective PCI have superior short- and long-term outcomes up to 1 year when compared with unmarried patients. These benefits persist after adjustment for multiple traditional cardiovascular risk factors.

Section snippets

Methods

The study protocol was approved by the institutional review boards of MedStar Washington Hospital Center and the MedStar Health Research Institute. A dedicated data coordinating center performed all data management and analyses. Clinical observational analysis of consecutive patients on PCI from 2003 to 2011 was performed. Patients were divided according to their marital status, comparing married patients with unmarried patients. The unmarried group included single, divorced, and widowed

Results

A total of 11,216 patients who had elective or urgent PCI were included in the current analysis. The average age was 64 ± 12 years, 65% were men, 66% were white, and 26% were African American. Percutaneous coronary intervention was performed for stable angina pectoris in 3,085 patients (28%), for unstable angina in 5,097 (46%), and for acute MI in 1,498 patients (13%).

Among the total study population, 6,141 patients (55%) were married, whereas 5,075 (45%) were unmarried. Significant differences

Discussion

The major findings of the current study indicate that married patients who undergo urgent or elective PCI have superior short- and long-term outcomes up to 1 year when compared with unmarried individuals. These outcome benefits persist after adjustment for multiple traditional factors associated with outcome after PCI. Subgroup analyses of men and women indicated that both genders derived a similar benefit from being married.

Previous studies have shown conflicting results with regard to

Limitations

There are several limitations to our study. It was a post hoc analysis and, as such, is subject to the limitations of retrospective studies. Results may have possibly been affected by unknown confounders. Despite the high number of patients included, it is a single-center registry and unknown confounders may limit the general applicability of our findings. We did not subdivide the unmarried patients into subcategories such as single, separated, and widowed. However, there is a large body of

Conclusions

The present study provides evidence for a robust association between marital status of patients undergoing PCI and improved long-term outcomes up to 1 year. The advantage provided by marriage has independent effects for patients who undergo elective or urgent PCI. These findings are more pronounced in married men compared with married women. These findings should heighten awareness of physicians for socioeconomic risk factors beyond the standard cardiovascular disease risk factors and may

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